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members, but as such associations are the only portals to this Society and to the American Medical Association, all reputable and legally registered physicians, except those who practice or claim to practice or lend support to any exclusive or irregular system of medicine, shall be entitled to membership.

"No physician shall be admitted to or retain membership in a County Medical Association after the expiration of his present contract who has agreed to furnish medical services to any organization or union for a stipulated sum per member, or for other consideration than the regular local fee for such services." The State Society must accept every man who has been admitted to membership in a component association as one of its members, hence the State Society has an interest in and a right to see that each county association correctly interprets the spirit of this by-law and acts with discrimination in its application. In this matter the State Society represents the whole of which the county associations are component parts and the whole is greater than any of its parts.

This is a practical and comprehensive by-law. Any substitute for this that gave this discriminating power as to membership to the State Society instead of as now to the county associations would be cumbersome, unwieldy and inefficient in securing results. The State Society, through its councilors, or by special committee, could not enter a county and elicit facts as accurately or judge as justly as to the qualifications of a man for membership as could the county association in that county.

It is certain that at present there is not an equal discrimination among the various county associations in the selection and retention of members. This is true not only in a general sense as far as the original by-law is concerned, but flagrantly so in application of the amendment. Unless the State Society express some authoritative opinion in this matter, there may be as many interpretations of this by-law as there are county associations. All members are on an equal footing in the State Society, and it is manifestly unjust that a man should be admitted to this body from one county association who would be disqualified in another. Such a state of affairs is unjust to the State Society, to the county associations in their interrelations, and to individuals.

Strictly speaking, under the by-laws it is neither necessary nor legitimate that this committee make any recommendation as to enforcement of Chap. XII, Sec. 2. Chap. VII, Sec. 5, in part is as follows: "The Council shall be the board of censors of the Society. It shall consider all questions involving the rights and standing of members, whether in relation to other members, to the component associations, or to this Society,” etc. Under this by-law the Council have power to enforce the section under consideration. However, we would recommend that each component association incorporate in its by-laws a section similar to the amendment to Sec. 2, Chap. XII of the State Society By-laws and be guided thereby in the selection of its members. This will then place the matter of judging of qualification of members entirely within the county associations.

The purpose aimed at in this report is to have the matter of contract practice stated as fully as possible within reasonable limits. Your Committee have avoided making this report on their own authority alone, but have attempted to base it upon the best medical judgment not only of the state but of the entire country.

Respectfully submitted,

C. J. BARTLETT,

J. N. KENT,

S. B. OVERLOCK, Chairman.

(14) Report of the Committee on Colony Sanatoria for the Nervous Poor, by Dr. Rienzi Robinson (Danielson):

REPORT OF THE COMMITTEE ON COLONY

SANATORIA FOR THE NERVOUS POOR.

Mr. President and Gentlemen of the House of Delegates:

For a number of years there have been in operation in some parts of Germany sanatoria for the care of patients suffering from certain types of nervous diseases who cannot be advantageously treated in hospitals for the insane, psychopathic institutes, or the ordinary type of hospital for nervous diseases. The

necessity for such institutions was suggested by Otto Mueller as early as 1873, but it was not until after Moebius had emphasized the need for them towards the end of the last century that they became a reality. In 1899 the oldest of these institutions, Haus Schoenow near Berlin, opened its doors, and since then two others of practically the same scope have been put into operation. It may be well to briefly state the types of cases that are treated in these institutions, and to call attention to certain necessary factors as to situation, management and equipment that are necessary to make them a success. In a general way any case of nervous disease which is capable of cure or even of improvement may properly be received into such a sanatorium. The majority of the patients who enter are suffering from neurasthenia, nervousness of the climacteric or other simple forms of nervousness, hysteria, mild chorea, or organic diseases of the nervous system in an early stage when much may still be done for the patient. Peripheral nervous lesions of a curable nature are also received, likewise the traumatic neuroses. All those with experience in the management of these institutions state that patients who are suffering from alcoholism or drug habits, from epilepsy, or from insanity must be rigorously excluded. The alcholics and drug habitues need a degree of restraint entirely incompatible with the lack of restraint which is a feature of the sanatoria for nervous diseases. The presence of epileptics and insane, especially the latter, has been shown to be distinctly detrimental to those suffering with neuroses.

The sanatoria of the type we are describing must be situated in the country, and preferably in attractive, well-wooded localities where a pleasing outlook is obtained. It is desirable that entire freedom from noise be obtained, but the institutions should preferably be in the neighborhood of large cities or of groups of small manufacturing centers. This is desirable not only because most of the patients will come from the cities, but also on account of the facility with which medical consultants in the various branches are obtainable. It is generally understood that such sanatoria should be constructed on a cottage or villa plan, and should not follow in their lines the architectural form which

suggests an institution. It is important for this class of patients that the surroundings should imitate as closely as possible home rather than institutional life. It is also desirable that the number of patients be somewhat limited, not more than 150 at the outside being allowed in a single institution. Some authorities advise separate institutions for the sexes, but others claim that this is not an absolute necessity if proper restrictions be made.

In connection with the institution, which must of course possess adequate water supply and a heat, light and power plant, there must be provided facilities for light outdoor work about the place, for outdoor exercise in the form of drills and gymnastics, and for certain light indoor occupations, such as book binding, basket making and similar handicrafts. In some of the German institutions the work cure constitutes the main therapeutic measure. There must, however, also be ample provision for the application of physical therapy, including hydro-therapy, massage, electricity, etc.

The management of the institution must be in the hands of physicians who have had special training in nervous and also in mental diseases. The number of physicians need not be great, not more than one to each forty patients, but their special equipment for the work must be insisted upon, for in the treatment of such cases proper handling from the psychic standpoint is of extreme importance. An efficient matron is also said to be a necessity. The number of attendants needed is small, as bedridden patients are not accepted, and the individuals who enter are able to care for themselves.

The above description covers briefly the essential requirements of such an institution. It will be seen that the class of patients provided for is one that has hitherto received no attention in this country except in private institutions which, for financial reasons, are beyond the reach of the poorer classes. There can be little doubt that such institutions accomplish great good. The number of patients with nervous affections is much greater than those who are insane, though, of course, many of these cases are incurable and not suitable for such an institution. Patients with

the neuroses, however, are exactly those who need removal from their usual surroundings in order that a cure may be effected. If it were possible to place such patients in a sanatorium of this kind without cost, or at a reasonable cost to their families, it would undoubtedly be greatly to the benefit of all concerned. The Committee, therefore, feels strongly that the establishment of such institutions is highly desirable and should be brought about as soon as is feasible.

RIENZI ROBINSON,

April 24, 1911.

Chairman.

GEORGE BLUMER,

Secretary.

(15) Report of the Delegate to National Legislative Council, by Dr. Everett J. McKnight (Hartford):

REPORT OF THE DELEGATE TO NATIONAL
LEGISLATIVE COUNCIL.

Mr. President and Gentlemen of the House of Delegates:

The seventh annual conference of the American Medical Association on Medical Education and Medical Legislation was held at the Congress Hotel, Chicago, Ill., on March 1, 2 and 3 of this year.

The meeting was called to order by Dr. Arthur D. Bevan of Chicago, chairman of the Committee on Medical Education. The first day was devoted to papers and discussions upon medical education; the papers were unusually good and instructive, one being by Dr. George Blumer, Dean of the Yale Medical School. As two members of our State Examining Board were present, it is probable that they will report more in detail.

The second day was taken up with the consideration of Medical Practice Acts, with Dr. H. B. Favill, chairman of the Council on Health and Public Instruction, in the chair. With the exception of having three examining boards, I think we have as good a Medical Practice Act as any state in the Union.

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